EDITOR’S CHOICE The Nation’s Oral Health Inequities: Who Cares…
A
comprehensive vision of health that includes the mouth! We have a responsibility to continue to build the case for such vision, despite the inattention by national policymakers. Shifting sands lie beneath any efforts to ensure that all Americans have access to comprehensive health care that includes preventive oral health care and quality treatment. We find ourselves, as a nation, on the precipice of removing further supports that undergird the nation’s health and that of individuals whose only options are provided by public programs. As we observe the unfolding national drama and impending trauma, we are fully aware that those responsible for insuring standards of health care have not considered teeth or oral health as integral to good health. This is the worst of times; we need a vision on how to make it better. This supplemental issue of AJPH, sponsored by the Morehouse School of Medicine with a special grant from the W.K. Kellogg Foundation, reminds community members, multidisciplinary practitioners, and policymakers of the oral health inequities extant in our population. Inequities are not equitably shared, and the disparities witnessed parallel the “isms” of race, income, and class, as well as the attendant neglect and historical separation, and even segregation. In sum, the past continues to be prologue for our future, particularly when measured by the lack of an oral health home, of racial and ethnic diversity among providers, and of individuals from underserved groups admitted to dental and dental hygienist schools, and even by the diversity of the cadre of providers, such as dental therapists, who could reach more underserved people where they live, at affordable rates. Drive-by dentistry, delivered out of a van, need not be the solution for the isolated poor. If considered, these changes to services delivery and the dental workforce could help reduce and prevent oral health inequities among those bearing Supplement 1, 2017, Vol 107, No. S1
AJPH
the greatest burden of oral diseases. This special issue—through scholarly articles addressing oral health inequities, vulnerable populations (e.g., the incarcerated and elderly), provider diversity, policy development, public health practice, and research—embraces a belief that protection of the public’s health must include access to affordable and preventive oral health care services for everyone. Far too often, research studies and payment programs focus on children or child-bearing women to the neglect of non–child-bearing women and poor men. Senior citizens on Medicare have no benefit supporting routine oral health services. And fulsome, expensive, and exclusionary national health data reports give rise to numerous publications but ignore those incarcerated in our jails and prisons, most of whom are from communities of color. We know better than we do! Historic transformation requires only a few visionary leaders who will not allow their “light to be hidden under a bushel” (King James Bible, 1611, Matthew, 5:15 and 5:16), and whose commitment to change overshadows the viewpoints and voices of naysayers who have brought us to this crisis in human health care, this continual segregation of the haves from the have-nots. This volume serves as guidepost. Much more needs to be written. This is not the end of the story. The best of times beckon us. The drumbeat begins now! Henrie Monteith Treadwell, PhD Guest Editor Morehouse School of Medicine Atlanta, GA doi: 10.2105/AJPH.2017.303957
77
YEARS AGO
Problems of Dental Care in Sparsely Settled Rural Communities Many counties in the sparsely settled western states could not and never will be able to support a dentist, yet there are many people living there in need of dental service. . . . Certainly definite action is imperative to meet this situation. Unquestionably more public funds . . . must be appropriated for this work. It may be necessary for health agencies to underwrite professional personnel at least temporarily if they are to be attracted to small sparsely settled communities. . . . While dental health activities have made rapid strides since the passage of the Social Security Act, the amount of funds and the number of personnel are entirely inadequate to cope with a health problem so widespread. From AJPH, August 1940
38
YEARS AGO
Dental Care Utilization in Urban, Low-Income Areas With infusion of both financial (Medicaid) and dental service resources (community health centers or CHCs), the . . . low-income areas studied experienced greatly increased dental utilization over a relatively short period of time. . . . The continued gaps in dental utilization rates between national and low-income areas, however, show that provision of increased financial and dental resources increased utilization only to a limited extent . . . The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care. From AJPH, October 1979
Editor’s Choice
S5
A
comprehensive vision of health that includes the mouth! We have a responsibility to continue to build the case for such vision, despite the inattention by national policymakers. Shifting sands lie beneath any efforts to ensure that all Americans have access to comprehensive health care that includes preventive oral health care and quality treatment. We find ourselves, as a nation, on the precipice of removing further supports that undergird the nation’s health and that of individuals whose only options are provided by public programs. As we observe the unfolding national drama and impending trauma, we are fully aware that those responsible for insuring standards of health care have not considered teeth or oral health as integral to good health. This is the worst of times; we need a vision on how to make it better. This supplemental issue of AJPH, sponsored by the Morehouse School of Medicine with a special grant from the W.K. Kellogg Foundation, reminds community members, multidisciplinary practitioners, and policymakers of the oral health inequities extant in our population. Inequities are not equitably shared, and the disparities witnessed parallel the “isms” of race, income, and class, as well as the attendant neglect and historical separation, and even segregation. In sum, the past continues to be prologue for our future, particularly when measured by the lack of an oral health home, of racial and ethnic diversity among providers, and of individuals from underserved groups admitted to dental and dental hygienist schools, and even by the diversity of the cadre of providers, such as dental therapists, who could reach more underserved people where they live, at affordable rates. Drive-by dentistry, delivered out of a van, need not be the solution for the isolated poor. If considered, these changes to services delivery and the dental workforce could help reduce and prevent oral health inequities among those bearing Supplement 1, 2017, Vol 107, No. S1
AJPH
the greatest burden of oral diseases. This special issue—through scholarly articles addressing oral health inequities, vulnerable populations (e.g., the incarcerated and elderly), provider diversity, policy development, public health practice, and research—embraces a belief that protection of the public’s health must include access to affordable and preventive oral health care services for everyone. Far too often, research studies and payment programs focus on children or child-bearing women to the neglect of non–child-bearing women and poor men. Senior citizens on Medicare have no benefit supporting routine oral health services. And fulsome, expensive, and exclusionary national health data reports give rise to numerous publications but ignore those incarcerated in our jails and prisons, most of whom are from communities of color. We know better than we do! Historic transformation requires only a few visionary leaders who will not allow their “light to be hidden under a bushel” (King James Bible, 1611, Matthew, 5:15 and 5:16), and whose commitment to change overshadows the viewpoints and voices of naysayers who have brought us to this crisis in human health care, this continual segregation of the haves from the have-nots. This volume serves as guidepost. Much more needs to be written. This is not the end of the story. The best of times beckon us. The drumbeat begins now! Henrie Monteith Treadwell, PhD Guest Editor Morehouse School of Medicine Atlanta, GA doi: 10.2105/AJPH.2017.303957
77
YEARS AGO
Problems of Dental Care in Sparsely Settled Rural Communities Many counties in the sparsely settled western states could not and never will be able to support a dentist, yet there are many people living there in need of dental service. . . . Certainly definite action is imperative to meet this situation. Unquestionably more public funds . . . must be appropriated for this work. It may be necessary for health agencies to underwrite professional personnel at least temporarily if they are to be attracted to small sparsely settled communities. . . . While dental health activities have made rapid strides since the passage of the Social Security Act, the amount of funds and the number of personnel are entirely inadequate to cope with a health problem so widespread. From AJPH, August 1940
38
YEARS AGO
Dental Care Utilization in Urban, Low-Income Areas With infusion of both financial (Medicaid) and dental service resources (community health centers or CHCs), the . . . low-income areas studied experienced greatly increased dental utilization over a relatively short period of time. . . . The continued gaps in dental utilization rates between national and low-income areas, however, show that provision of increased financial and dental resources increased utilization only to a limited extent . . . The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care. From AJPH, October 1979
Editor’s Choice
S5
